Provider Demographics
NPI:1003018813
Name:TAYLOR, DONALD HARRY (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:HARRY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10617 SHOOTING STAR LN.
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5747
Mailing Address - Country:US
Mailing Address - Phone:301-645-7352
Mailing Address - Fax:
Practice Address - Street 1:4545 CRAIN HWY
Practice Address - Street 2:SUBSTANCE ABUSE SERVICES
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-1050
Practice Address - Country:US
Practice Address - Phone:301-609-6600
Practice Address - Fax:301-934-1234
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00284502084A0401X, 2084F0202X, 2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD010882M25OtherPROVIDER
MD481106200Medicaid
MDF0720Medicare ID - Type Unspecified